Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | F1114234 | MN |
NPI | 1003213430 |
---|---|
Provider Name | Jacqueline Maria Sellner |
First Address | Omaha, NE 68154 |
Second Address | Omaha, NE 68154 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/12/2014 |
Last Update Date | 16/07/2015 |